Permit [/
WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
'eV Electrical Inspection Section APPLICATION
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: 503 640 -3470 Fax: 503 693-4412
PLEASE PRINT Project/Permit
Number LC '5- CJJ1,3 Date 6111' - S5
Please complete all sections, 1 through 5. ,
1. Location of installation - 4. Complete Fee Schedule below
Address R 3 1 S U.) W y vi cutige- Number of Inspections per permit allowed
........--- Building Service included: Items Cost(ea.) Sum
City ‘ k C- -D Suite No. FC I
Tenant Name - I A. Residential - per unit
> OC.- /
(if commercial) O )P Th T1 d N S 1000 sq. ft. or less $110.00 4
Each additional 500 sq. ft
Tax Lot Map No. or portion thereof $25.00
Limited Energy $25.00 1
Thomas Map Book: Page: Section: Each Manufd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
� B. Services or Feeders
Commercial IX Residential I I Installation, alterations or relocatio J d
200 amps or less $60.00 ! 2
201 amps to 400 amps $80.00 2
2a. Contractor installation onl v: 401 amps to 600 amps $120.00 2
Electrical Contractor COMMERCIAL CAL CORP • 601 amps to 1000 amps $180.00 2
Address 10928 NE KILL•INCSV&)RTH Over 1000 amps or volts $340.00 2
Date 6/11/99 Job Number 246 Reconnect only $50.00 2
Property Owner
Contractor's License No. 26_r C. Temporary Services or Feeders
Contractor's Board Reg. No. 6145 Installation, alteration or relocation
1 g 200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n `' 401 amps to 600 amps $100.00 2
License No. I7`I S Phone No. 255 -9822 _ Over 600 amps to 1000 volts see 'B' above
2b. For owner installations: D. Branch Circuits .
New, alteration or extension per panel
Print Owner s Name Phone No. a) The fee for branch circuits with
purchase of service or feede "'Jn
Address Each branch circuit i 1 $5.00 LL �v 2
b) The fee for branch circuits without
City State Zip purchase of service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own Each add'nl branch circuit $5.00 2
which is not intended for sale, lease or rent. E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
Owner's Signature Each sign or outline lighting $40.00 2
Signal circuit(s) or a limited
3. Plan Review section (if required) energy panel, alteration
Please check appropriate item and enter fee In section 5B. or extension $40.00 2
1 & 2 family dwellings over 320 amps sic meter F. Each additional inspection over the allowable
-
4 or more residential units in one structure in any of the above
Per inspection $35.00
Service over 225 amps; feeder 400 amps or more Per hour $55.00
System over 600 volts nominal In Plant $55.00
Building over 3 stories in height aa
Building over 10,000 sq. ft. 5. Fees I -
Occupant load over 99 persons A. Enter total of above fees $ ..
Manufactured Structures Park or Recreational 5% Surcharge (.05 X total fees) $
Vehicle Park; new, addition or alteration Subtotal $ :0_-_
Classified area or structure containing special B. Enter 25% of line A for
-
occupancy as described in N.E.C. Chapter 5 Plan Review if required (Section 3) $
Submit 2 sets of plans with application where any of the Subtota $
Less Bulk Label Fee
above apply. Not required for temporary construction 5�
services. Balance Due $
For Inspections call This permit becomes null and void If the work authorized by the permit Is not commenced
640 -3561 or 693 -4415 within 180 days from date of Issuance of such permit or If the work authorized Is
suspended or abandoned at any time after work la commenced for a period of 180 days.
24-hour recorder, one working day In advance of need Electrical Permits are non - refundable and non- transferable.
5/93
CITY OF TIGARD BUILDING INSPECTION NOTICE
t4 ispection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: _4 1 - ,P _C _ ,i
I
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post /Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. ect.
Date Requested: 7 /2-0 1 l Time: AM PM
Address: / & 3 3 Le. !er , 3 0- A 0 ,
Builder,1 ?,4 .-q/-625O p �p Permit #: 4' f" ^ QC:9C,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
--- rh - 5: ; C t /
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Inspector: f G _, • G Date: ,?,
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
— Call For Reinsp. C r